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Plasmacytoma of the Cervical Spine

Chiro.Org Blog: A chiropractor recognized a large, expansile plasmacytoma in the C3 vertebral body and referred the patient for surgical care. This case suggests that all practitioners of manual medicine should provide a careful analysis of the patient’s clinical presentation and, if clinically warranted, radiographic examination to determine neck or back pain is due to an underlying malignant condition. […]

Chiropractic Gains Ground During Texas Legislative Session

Chiro.Org Blog: Texas Gov. Greg Abbott signed into law Senate Bill 304, continuing the Texas Board of Chiropractic Examiners (TBCE) and upholding the right of licensed doctors of chiropractic in Texas to diagnose patients. It caps a historic legislative session for the chiropractic profession in Texas. […]

Mechanisms of Low Back Pain:
A Guide for Diagnosis and Therapy

Chiro.Org Blog: CLBP represents the leading cause of disability worldwide and is a major welfare and economic problem. [1] Given this complexity, the diagnostic evaluation of patients with LBP can be very challenging and requires complex clinical decision-making. Answering the question, “what is the pain generator?” among the several structures potentially involved in CLBP is a key factor in the management of these patients, since a diagnosis not based on specific pain generator can lead to therapeutic mistakes. This article aims to provide a brief clinical guide that could help in the identification of pain generators through a careful anatomical description, thereby directing clinicians towards the correct diagnosis and therapeutic approach. […]

Life-Threatening Lower Back Pain

Chiro.Org Blog: This article will help clinicians identify life-threatening conditions that present with lower back pain. Intra-abdominal bleed (e.g. aortic aneurysm), infection and tumor are the most dangerous causes of lower back pain and carry the potential for devastating consequences. Table 1 identifies red flags that should raise suspicion of a serious disorder. [1] […]

Multiple Venous Thromboses Presenting as Mechanical Low Back Pain in an 18-Year-Old Woman

Chiro.Org Blog: The purpose of this case report is to describe a patient who presented with acute musculoskeletal symptoms but was later diagnosed with multiple deep vein thrombosis (DVT) […]

Identification of Internal Carotid Artery Dissection

Chiro.Org Blog: The problem any chiropractic physician faces in identifying ICAD patients is that the condition may present without any symptoms or the symptoms may appear benign (e.g., headache, neck pain or cervicogenic dizziness). Consequently, it may be impossible to identify some ICAD patients, especially in the early stages of the pathology. As the ICAD progresses and neural blood flow is compromised, the symptom picture typically manifests more completely. The chiropractic physician must be alert to characteristic findings of a progressing ICAD, since an immediate referral to a medical specialist may be required. […]

The Etiology of Cervical Artery Dissection

Chiro.Org Blog: The etiology of cervical artery dissection (CAD) is unclear, although a number of risk factors have been reported to be associated with the condition. On rare occasions, patients experience CAD after cervical spine manipulation, making knowledge about the cervical arteries, the predisposing factors, and the pathogenesis of the condition of interest to chiropractors. This commentary reports on the relevant anatomy of the cervical arteries, developmental features of CAD, epidemiology of the condition, and mechanisms of dissection. […]

Recognition of Spontaneous Vertebral Artery Dissection

Chiro.Org Blog: This case highlights the potential for patients with vertebral artery dissection to present with nonspecific musculoskeletal complaints. Neurological symptoms may not manifest initially, but their sudden onset indicates the possibility of an ischemic cerebrovascular event. We suggest that early recognition and emergent referral for this patient avoided potential exacerbation of an evolving pre-existing condition and resulted in timely anticoagulation treatment. […]

Elongated Styloid Processes and Calcified Stylohyoid Ligaments in a Patient With Neck Pain: Implications for Manual Therapy Practice

Chiro.Org Blog: Neck pain in the presence of elongated styloid processes (ESPs) and calcified stylohyoid ligaments (CSLs) can be associated with Eagle syndrome, which can include ipsilateral head and neck pain, odynophagia, dysphagia, and cerebrovascular symptoms. This case, initially thought to be Eagle syndrome, highlights proper diagnostic workup for this condition and presents potential contraindications to consider with regard to cervical spine manipulation in such patients. Manual therapy precautions pertaining to cervical spine manipulation may be appropriate in cases involving ESPs and calcified stylohyoid ligaments. […]

Life-Threatening Conditions That Walk:A Clinician’s Review

Chiro.Org Blog: Daniel, et al., have identified the six most common life-threatening conditions that a chiropractic physician is likely to encounter in clinical practice.1 The goal of this article is to translate the current evidence-based knowledge of these conditions into a quick-scan diagnostic and management reference for cancer, abdominal aortic aneurysm, venous thromboembolism, stroke, myocardial infarction, and subdural hematoma. […]

Assessment of Patients With Neck Pain

Chiro.Org Blog: The purpose of this literature review was to synthesize the existing literature on various definitions, classifications, selection criteria, and outcome measures used in different studies in patients with neck pain. […]

Joint Assessment – P.A.R.T.S.

Chiro.Org Blog: Doctors of chiropractic are portals of entry to the health care system for many patients seeking health care services. As such, they must maintain broad and thorough assessment/diagnostic skills. Before employing any therapy, a clinician must first determine if there is a need for treatment. Therefore, the clinical information that any primary contact provider would want, including a case history, physical examination, clinical laboratory findings, radiographic findings, and any other tests necessary to check for suspected health problems, is needed. […]

ICD-10 Guidelines for DCs

Chiro.Org Blog: Chiropractic physicians typically use codes from just four or five of the 21 chapters available in ICD-10-CM. These include, but are not necessarily limited to, the codes from Chapter 6, diseases of the nervous system; Chapter 13, diseases of the musculoskeletal system and connective tissue; Chapter 18, symptoms, signs and abnormal clinical findings, not elsewhere classified; Chapter 19, injury, poisoning and certain other consequences of external causes. Most doctors of chiropractic (DCs) do not employ certified coders to research all of the coding changes that are specific to their specialty. They are compelled to learn coding while running a small business and continuing to focus on the clinical needs of their patients. A thorough understanding of all the guidelines in ICD-10-CM is wise, but listed below are a handful of guidelines that should be the focus. […]

A Diagnosis-based Clinical Decision Rule For Spinal Pain Part 2: Review Of The Literature

Chiro.Org Blog: Accurate diagnosis or classification of patients with spinal pain has been identified as a research priority [1]. We presented in Part 1 the theoretical model of an approach to diagnosis in patients with spinal pain [2]. This approach incorporated the various factors that have been found, or in some cases theorized, to be of importance in the generation and perpetuation of neck or back pain into an organized scheme upon which a management strategy can be based. The authors termed this approach a diagnosis-based clinical decision rule (DBCDR). The DBCDR is not a clinical prediction rule. It is an attempt to identify aspects of the clinical picture in each patient that are relevant to the perpetuation of pain and disability so that these factors can be addressed with interventions designed to improve them. The purpose of this paper is to review the literature on the methods involved in the DBCDR regarding reliability and validity and to identify those areas in which the literature is currently lacking. […]

A Theoretical Model For The Development Of A Diagnosis-based Clinical Decision Rule For The Management Of Patients With Spinal Pain

Chiro.Org Blog: Chronic spinal pain is an increasingly common problem in Western Society [1]. Spinal disorders exact great costs, in terms of both direct medical costs and indirect costs related to disability and lost productivity [1-3]. A number of researchers have attempted to improve our ability to identify the causes of spinal pain as well as to diagnose and treat patients with this problem. In spite of this, accurate diagnosis, leading to specific, targeted treatments, of patients with spinal pain has been elusive. […]